Looking for endo that deals with ED&TRT, in Denville, NJ 07834 neighborhood. - MESO-Rx

JanSz · #1 (**permalink**) 07-16-2006, 10:51 PM

16 July 06
Looking for endocinologist that deals with ED & TRT, Denville, NJ 07834 neighborhood.
I need help with my ED, most likely tweaking of Arimidex/Avodart doses, possibly reducing Androgel from 2 to 1.5 packets daily.
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I am 66yo male, 5'9", 155#, wear pants waist size 33x32 long, chest 39.5", 4 hr/week dancing (with sweating), 1 hr/week weight lifting (no sweat) supervised by my chiropractor-body builder, 6hr/week other light work.
Now sex 1/week with effort, up to 2 years ago sex 3/week and was looking for more, missing this experience.
Weak morning erections, sometimes none. Penis seams like lost lot of sensation to touch.
For good 15 years very rarely I have dreams, not sure if it is related in any way, but weird.
I am on self directed TRT for the last 3.5 years, since I started having ED problems.
I am getting script for Androgel, Avodart and in last year and half, Cialis, from my general doctor.
He also gives me a script for any blood test that I ask for, doctor himself is rather passive about any advice.
Refuses to give me script for Arimidex but I can get it from www.antiaging-systems.com , not really sure if it is real.
I also take lot (as recommended) supplements from http://www.lef.org/ , from there also protocols on TRT, DHEA and supplements.
Because my ED is getting worse, last couple of weeks I stopped Avodart and reduced Arimidex to 1/2 -1mg pill weekly, so far I see no difference.
Avodart, I was taking because of BHP, enlarged prostate, my PSA was in middle 4 range with out it.
I have a doctor in Manhattan that do not worry about anything else with me, except my prostate.
I had number of biopsies done to rule out PC.
If Avodart will cause ED then I probably will rather have TURP done and keep my sex going as long as possible.
While I was on my regular regimen:
Androgel-2x5gram daily
Arimidex 1/2-1mg pill daily
Avodart 1-0.5mg capsule daily
DHEA 16 pills 25mg each/daily
plus lots of other supplements
my
Testosterone 1039 ng/dL (241-827)
DHEA-sulfate 328 ug/dL (42-290)
Estradiol 26 pg/mL (0-51)
Estrone, serum 74 pg/mL (12-72)
Estrogens, total 65 pg/mL (40-115)
DHT 29 ng/dL (30-85)
Hematocrit 47.1% (36-50)
PSA 3.3 ng/mL (0-4)
%freePSA 15.2%
FSH <0.3 mIU/mL (1.5-9.3)
LH<0.3 mIU/mL (1.4-18.1)
IGF-1 100 ng/mL (75-212)
TSH 2.975 uIU/mL
have other, ask I may have it
--------------------------
I do not have good free Testosterone results, for about two weeks I took 3 packets of Androgel, that resulted in
Testosterone 1625 ng/dL (241-827)
Free Testosterone 50 pg/mL (6.6-18.1)
-------------------------
Before May2005 I was taking 1 packet of Androgel, no Arimidex and had
Testosterone 664 ng/dL (241-827)
Estradiol 38 pg/mL (0-53)
All labs are done at LabCorp

pmgamer18 · #2 (**permalink**) 07-17-2006, 12:05 PM

Ok first question did you put on the gel before you did your blood test. I have never seen anyone this high on 10 grams of Androgel. If you did it spiked your test and your E2 Estradiol test can be off. I feel your doing to much to keep your Estradiol down and your to low. If this happens then you lose wood in the morning taking Cialis will not get it up and it will be dam hard to reach an orgasm. Going to low is just as bad as being to high.

If I were you I would stop taking anything that lowers E' and E2. In 2 to 3 weeks depending on how long you can been to low. If you have not been to low to long you will come back up faster. First thing to happen is strong morning wood and your libido will come back.

As for finding a Endo for get about it they are not good Dr.'s for low T. Read the sticky Finding a new Dr. then go to this link.
http://www.tuneupyourt.com/
Click on find a new Dr. then put in your state.
Make sure you call and ask a lot of questions some of the Dr.'s that singed up are not good. Ask how many men with low T does the Dr. treat if a lot then ask if he uses HCG and treats high Estradiol with arimidex. You will know when you have found a good one. Or go to www.allthingsmale.com and read TRT: A Recipe for success and the HCG update print this and show it to your Dr. ask him if he will treat you using Dr. John over the phone. Also read the Adrenal Thread Sticky your IGF-1 is lower then mine. What was your first blood test before going on TRT do you know if your Primary or Secondary low T. Have you ever had an MRI on your Pituitary Gland.

JanSz · #3 (**permalink**) 07-17-2006, 08:13 PM

pmgamer18, I got your post, thank you.
I need more time to respond, probably latter at night or tommorow,
hope you do not mind.
JanSz

farmerjohn · #4 (**permalink**) 07-17-2006, 09:11 PM

If you're willing to travel you can try Eugene Shippen near Reading PA, not too far to drive from NJ. 610-777-7896. He specializes in this although is an internist.

I"m not so sure if you put the gel on right before your test if it would effect it that much. Look at the graph on the insert in the androgel package. There is a slight peak about 2 hours after application if I remember right but for the most part the levels are pretty constant throughout the day. Phil is right though, your total T is pretty high for androgel.

JanSz · #5 (**permalink**) 07-18-2006, 08:15 PM

Thank you for your thoughts, pmgamer18 and farmerjohn, please do not give up on me.
--------
Dr Eugene Shippen is (only) 110 miles away, in the end that may be my best choice.
From http://www.tuneupyourt.com/ I got Dr. Marc Greenstein 16 Pocono Rd,
Denville, NJ, right in my neighborhood. I will be calling him, not sure how good this lead is, the web site mentions that their program ended July 31/2004.
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I am applying Androgel around 9AM and having test about 1PM, gel is not applied in the inside elbow where needle goes in to take a blood. I am kind of light weight, 155# and do not wash my right had for few hours so I maybe getting more of it. Actually I am little intrigued by this comment because Androgel leaflet says to expect
566 ng/dL (+-262) on 5g and
792 ng/dL (+-294) on 10g
my tests (as per my initial letter) show
664 and 1039 respectively.
On 15g I tested 1625 so, I thought that was as expected.
Bottom line, was is the experience on this board, how much should I use to get correct results. For me, correct means I get my libido back to working order. As of now I am taking 2x5g Androgel daily, I have a script for 3 packets, but at this moment I think it may be too much. Comments?
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On 5g Androgel my FreeTestosterone was low, 9.5pg/mL (2.6-64.8)
On 10g it went up to 27 still not that hot.
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I have stopped Arimidex, now just wait and see, I will have to wait little longer to make sure if that will do the trick.
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When I first started having ED problems, I was searching blind, trying things nothing worked.
Eventually Alpha Male from
http://herbalpowers.stores.yahoo.net/
worked for me, even though they pushed LJ100 and I still have lots of them unopened.
--------
When Alpha Male stopped working I already had some education from
http://www.lef.org/
DHEA Restoration Therapy
http://www.lef.org/protocols/metabol...oration_01.htm
Male Hormone Modulation Therapy
http://www.lef.org/protocols/prtcls-...prtcl-130.html
Benign Prostatic Hyperplasia (BPH)
studies of a newer aromatase inhibitor known as mepartricin (not yet approved in the United States)
how to get meparticin?????
http://search.lef.org/LEFCMS/aspx/Pr...x?CmsID=114098
Exercise Enhancement and Risk Precautions
http://www.lef.org/protocols/prtcl-140.shtml#summary
Alphabetical Listing of Blood Test
http://www.lef.org/protocols/prtcl-072a.shtml#alphalist
Medical Testing Protocols
http://www.lef.org/protocols/prtcls-...prtcl-072.html
The 10 Most Important Blood Tests
http://www.lef.org/magazine/mag2006/...t_blood_01.htm
COMPREHENSIVE TESTS FOR MEN AND WOMEN
http://www.lef.org/bloodtest/index.htm?source=mag0605
PSA, Prostate Cancer,Avodart, Proscar
http://www.lef.org/magazine/mag2005/jun2005_awsi_01.htm
also
The Life Extension Revolution By Philip Lee Miller, M.D. With Monica Reinagel
http://www.lef.org/newshop/items/item33675.html
and
Testosterone Syndrome by Eugene Shippen
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With 1/100 of above information comprehended, my General doctor offers me Androgel script for my problems.
I have waited over a year to take him on that offer. I have enlarged prostate and since about 1994 some difficulties in urinating but I void completely. I have used that time to have my doctor in Manhattan (Sloan Kettering) check my prostate, I had about 5 biopsies until I think that at least for now I do not have prostate cancer. With that behind me I got script for Androgel and it worked beautifully. After about a year I had to increase dose to 2x5g Androgel and it worked until 3x5g did not make a difference. I must have killed my libido with Arimidex and first Proscar and latter Avodart. I have also used Minoxidil for my hair but stopped when switched to Proscar. Meparticin would have been better, maybe??
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At Sloan Kettering, my prostate doctor did not want to hear about my ED, he refer me to specialist, one floor up.
Very little help, but I got script for Cialis, but who knows may be all that there is, except that latter on Androgel worked for quite some time. Ok, so I have some tests from before I took anything, well except the herbs, Alpha Male and many others herbs.
The sex doc found that my pines feels healthy to him, my testis were also ok, but the tubes were stretched. For long time (guess 10-15y) I would have a pain in testis if I wore loose boxers for too long, my scrotum was very relaxed and I think loosely hanging testis were stretching the tubes. So to stop pain I wore swimming, tight shorts. When I started on Androgel the scrotum got tight again.
All this long explanation plus tests are supposed to help in making decision, do I have primary or secondary hypogonadism.
My testis were firm and I think large, now they shrunk and are soft.
My first tests :
(7/2003)(ordered by my general doc, so hi could be justified giving me script for Androgel
Testosterone 255 nh/dL (241-827) Lab Corp (7/2003)
(Jan/2004)(ordered by sex doc at Sloan)
Testosterone 311 ng/dL (241-827) done in local hospital lab
the rest of tests hospital lab farmed out to Quest Diagnostic
Free Testosterone 6.0 pg/mL (2.6-64.8)
Estradiol 24 (0-52)
LU 5.7 miu/mL (1.5-9.3)
Prolactin 7.2 ng/mL (2.1-17.7)
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That is all, comments please.
JanSz

**HeadDoc** · #6 (**permalink**) 07-19-2006, 12:06 AM

here a reference to the offices of Dr. Eric Braverman

http://www.pathmed.com/p/28.html

JanSz · #7 (**permalink**) 07-20-2006, 01:39 PM

Before I get to the doc, it may take a while, I have some questions:
If I stay away from Arimidex and Avodart and take only Androgel:
1.Approximately what dose of Androgel is expected to be the "right" dose?
2.What Estradiol level is too high?
3.Does Avodart actually interfere with my erections or it is only due to excessive use of Arimidex?
anything else?
JanSz

pmgamer18 · #8 (**permalink**) 07-20-2006, 04:05 PM

Quote:

Originally Posted by JanSz

Before I get to the doc, it may take a while, I have some questions:
If I stay away from Arimidex and Avodart and take only Androgel:
1.Approximately what dose of Androgel is expected to be the "right" dose?
Best to start at the 5 gram does and then test in two weeks to see where you at if you still not up into the upper 1/3 of your labs range for both Total and Free T then up the does to 10 grams.
2.What Estradiol level is too high?
Some men can do good with higher levels of Estradiol best to keep it between 10 to 30 I shoot for 20/
3.Does Avodart actually interfere with my erections or it is only due to excessive use of Arimidex?
Avodart does cause ED and loss of seamen levels.
http://www.fda.gov/Cder/consumerinfo...fo/avodart.HTM
But doing to much of Arimidex can do this also.
I had a TURP done never will I ever recommend this to my worst enemy. It was hell I was sent home and told I could walk around. I started bleeding it all went into my bladder and coagulated blocking up my bladder so I could not void I ended up in the ER with a dam big tube stuck up my penis wile they tryed to flush out the coagulated blood this took 3 hrs with Dr.'s switching because they were getting tired. Not a yr. went by and it started go come back slow voiding. I later found out it was the high Estradiol that did this to my prostate and If I would have got it down I would not have needed the TURP. My brother is in this boat now and in the process of getting his Estradiol checked he had to go to 4 different Dr.'s to get one that knows about high Estaradiol and slow voiding. In the mean time he is putting a tube up his penis to empty this bladder. The Dr. he is seeing now has him on Arimidex. But told him it will take some time after getting his estradiol down before they will know it this works but the Dr. seems to think it will.
http://hcd2.bupa.co.uk/fact_sheets/html/TURP.html
anything else?
JanSz

There was a lot to read here in your post so don't remember if you had it checked but you do need to have your Estradiol checked before you try taking Arimidex again. My Thinking is to stop all the supplements your on if your still doing them and just try the Androgel do not do 15 grams all this did for me was drive my E2 way up.

pmgamer18 · #9 (**permalink**) 07-20-2006, 04:07 PM

WTF happened to my last post.

farmerjohn · #10 (**permalink**) 07-20-2006, 10:53 PM

15 grams of Androgel must retail at about $750 per month, not to mention the estrodial problems. You need to try a compounded cream at a much higher concentrataion so you dont have such a high volume to apply to your skin. This will not only be a fraction of the cost but will also help keep estrodial down. The cost of the compounded cream may be on the order of $50 versus $750 at my pharmacy for androgel per month.

JanSz · #11 (**permalink**) 07-22-2006, 06:06 PM

July 22/06
I continue my 10 gram Androgel, in last two weeks I stopped Arimidex and Avodart, my pines just started to have little sensitivity, got morning wood last 2 days. I am planning to have a sex without Cialis.

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Posted by pmgamer18
My brother is in this boat now and in the process of getting his Estradiol checked he had to go to 4 different Dr.'s to get one that knows about high Estaradiol and slow voiding.
-----------------------
Please post any internet reference that discusses Estradiol enlarging prostate.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Posted by farmerjohn
15 grams of Androgel must retail at about $750 per month, not to mention the estrodial problems.
---------------------------
I have used 15 grams of Androgel only for about 3 weeks, then I got my Testosterone and Free Testosterone checked, It was way too high and I am back to my "normal" 10 grams. I have prescription plan with small co-pay.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Reason that I stay on 10 grams of Androgel is that, reading
http://www.lef.org/protocols/prtcls-...prtcl-130.html
I got impression that level of Testosterone (in a way) is not a factor, the important is Free Testosterone. On 5 grams of Androgel my Free Testosterone was to low, 9.5 pg/mL (2.6 to 64) done at Quest Teterboro Lab, not sure, it possibly is same as Quest Diagnostic as mentioned in above LEF protocol.
I started 10 grams of Androgel on Apr 13/2005
I had two blood tests since,
8/26/05
Test-822 ng/dL (241-827)
FreeTest 27.0 pg/mL (6.6-18.1)range for 60y-old, and (9.3-26.5) range for 20-29 years old

and 4/28/06
Test 1039 ng/dL (241-827), no Free Test performed

So, I think, I am about right with FreeTest
Then I added Arimidex and Avodart, one of them, or both caused my ED.
Actually I am out of both of them last two weeks, and I think I just started to see little positive difference.
__________________________________________________ _
I am glad I found this board with all of discussions that are going on Men's Health Forum.
Also John Crisler, DO
http://www.allthingsmale.com/papers.htm
and
http://www.allthingsmale.com/word_docs/HCGupdate.doc
have given me new information.
Mainly HCG and his statement, I quote:
" But there’s another metabolic reason to employ this protocol. The P450 Side Chain Cleavage enzyme, which converts CHOL into pregnenolone at the initiation of all three metabolic pathways CHOL serves as precursor (the sex hormones, glucocorticoids and mineralcorticoids), is actively stimulated, or depressed, by LH concentrations. It is intuitively consistent that during conditions of lowered testosterone levels, commensurate increases in LH production would serve to stimulate this conversion from CHOL into these pathways, thereby feeding more raw material for increased hormone production. And vice versa. Thus the addition of HCG (which also stimulates the P450scc enzyme) helps restore a more natural balance of the hormones within this pathway in patients who are entirely, or even partially, HPTA-suppressed."

My testicles have shrunk long ago, if I get HCG, revive my testicles, and have the P450 going plus all the testosterone that they may add, I may end up on 5 grams Androgel only.

Wonder if I should go and talk to this new endocrinologist that I found or just buy it here, use 250IU twice weekly and see what happens?
If endo would be cooperative and give me script then I may save money.

Is there a thread that discusses HCG, how to buy it, how to mix, storage, refrigeration and so on?
---------------------------------------------------------------
I have a question on Estradiol, after reading John Crisler's article, I noted that he want Estradiol tested using "ultrasensitive" assay. I do not know how Lab Corp did it, does any body know? I will call Monday, may be they will tell me.

Please help me in my journey, make comments.
JanSz

pmgamer18 · #12 (**permalink**) 07-22-2006, 08:35 PM

Endo's are not good Dr.'s for low T I would not go over 10 grams of gel and Arimidex will kill your sex life is you do to much of it and get you Estrodiol down to low. Best to keep it at 10 to 30 doing this should bring down you prostate it did for me. Here is a link on the Estradiol test.
http://www.labcorp.com/datasets/labc...o/sr012000.htm
We use the sensitive test because the other test only go down to 20 so if you less then this the test will say <20 but you can be at 19 and this is good. You need a test that goes down to 10 or 0.

JanSz · #13 (**permalink**) 07-24-2006, 05:23 PM

Quote:

Originally Posted by pmgamer18

Endo's are not good Dr.'s for low T I would not go over 10 grams of gel and Arimidex will kill your sex life is you do to much of it and get you Estrodiol down to low. Best to keep it at 10 to 30 doing this should bring down you prostate it did for me. Here is a link on the Estradiol test.
http://www.labcorp.com/datasets/labc...o/sr012000.htm
We use the sensitive test because the other test only go down to 20 so if you less then this the test will say <20 but you can be at 19 and this is good. You need a test that goes down to 10 or 0.

My last Estradiol test shows
26 pg/mL (0-53) done by Labcorp, (10-30)LEF recomended range

Do I take that I am (I was) ok with Estradiol, and my test is valid?
I am uneasy because in lab report I do not see anything about it being done using "ultra-sensitive" method.
JanSz

pmgamer18 · #14 (**permalink**) 07-24-2006, 07:33 PM

Quote:

Originally Posted by JanSz

My last Estradiol test shows
26 pg/mL (0-53) done by Labcorp, (10-30)LEF recomended range

Do I take that I am (I was) ok with Estradiol, and my test is valid?
I am uneasy because in lab report I do not see anything about it being done using "ultra-sensitive" method.
JanSz

If the labs range is 0 to 53 then it is a sensitive test all a test like this does is go to zero. Your E2 looks ok if it is the last test you had done. Doing 15 grams of gel drove my E2 nuts. Stay on top of this because men are age E2 goes up and down fast.

JanSz · #15 (**permalink**) 07-25-2006, 12:39 PM

Listed below are endocrinology assays performed at LabCorp.
http://labcorp.com/pdf/Endocrinology...bCorp_1023.pdf

Testosterone:
Free T or not Free T
http://labcorp.com/pdf/Testosterone_Article_for_Web.pdf

Thyroid Cascade Testing
Differential Laboratory Diagnosis of Thyroid Dysfunction
http://labcorp.com/pdf/Thyroid_Cascade_LabCapsule_1.pdf

A New Approach in the Diagnosis of Thyroid Dysfunction
http://labcorp.com/pdf/Thyroid_Cascade_Flyer_1644_1.pdf